Los servicios de salud y el mercado

En el presente artículo se realiza un análisis del mercado de los servicios de salud. Los servicios de salud, como los demás bienes, los demandan unos individuos mientras que otros individuos e instituciones los ofrecen. La demanda de servicios de salud y la oferta de éstos integran el mercado de servicios de salud. Las condiciones que se suelen dar en este mercado le alejan de lo que en economía se entiende como un mercado de competencia perfecta, resultando por lo tanto que no se suele alcanzar Ia eficiencia económica pues no se dan las condiciones para que el mercado pueda funcionar eficientemente.In the present article is analyzed the health services market. Health services, like other goods, are demanded by some individuals while other individuals and institutions offering them. The demand for health services and the supply of these make up the health services market. The conditions in this market usually give you away from what the economics are understood as a perfectly competitive market, resulting therefore you usually do not reach an economic efficiency because the conditions are not met in the market to function efficiently

La gestión sanitaria

La universalidad de la cobertura sanitaria, el envejecimiento de la población, la fuerte demanda de los servicios sanitarios, la introducción de tecnología punta, son algunas de las razones que han hecho que el gasto sanitario sea la partida que más haya crecido en los presupuestos estatales. Esto ha llevado a los gobiernos a establecer mecanismos de control del gasto para mantener el estado de bienestar que hace que la gestión sanitaria sea una auténtica necesidad. En los últimos tiempos todo lo que es técnicamente posible, ya no es económicamente asumible. Ello obliga a introducir conceptos económicos, tales como rentabilidad, eficiencia, y a buscar una relación idónea entre el coste de los beneficios y el beneficio social de los mismos para procurar una asignación equitativa de recursos sanitarios. De esta situación surgen conflictos entre los políticos, los expertos en gestión empresarial, los profesionales sanitarios, sobre todo clínicos, y los usuarios, a los que se dirige todo el sistema sanitario.The universal health coverage, the aging population, strong demand for health services, the introduction of cutting edge technology, are some of the reasons that have made health spending item that has grown in state budgets. This has led governments to establish control mechanisms expenditure of maintaining the welfare state makes health management is a genuine need. Lately everything that is technically possible, it is no longer economically acceptable. This requires introducing economic, such as profitability, efficiency, and to seek a suitable relationship between the cost of benefits and social benefits of the same to ensure an equitable allocation of health resources concepts. In this situation conflicts between politicians, business management experts, health professionals, especially clinicians, and users, to which the entire health system is directed arise

Grupos de riesgo por COVID-19 y sus estrategias para enfrentar la sobrecarga informativa en el primer año de la pandemia en Chile

As a part of the EIS-COVID project on the access and use of information during the COVID-19 pandemic in Chile, the objective of this paper was to ascertain how people’s informational environment was constructed during the first stage of the pandemic. It discusses the results of a qualitative study of people belonging to risk groups for COVID-19: people over 18 and under 65 with chronic diseases (hypertension and diabetes) and people 65 and over. Ninety semi-structured interviews were conducted in the Metropolitan and Valparaíso regions between September 2020 and January 2021. The results reveal the problematic nature of the information overload encountered by these groups and the strategies they used to navigate it: a) information avoidance; b) content corroboration and active search for reliable sources; and c) differentiated media use.Este artículo se enmarca en el proyecto EIS-COVID sobre acceso y uso de información en el contexto de la pandemia de COVID-19 en Chile. Su objetivo fue conocer cómo se constituyó el entorno informativo de las personas en la primera etapa de la pandemia. El artículo muestra los resultados de un estudio cualitativo enfocado en personas pertenecientes a grupos de riesgo por COVID-19: personas mayores de 18 y menores de 65 años con enfermedades crónicas (hipertensión y diabetes) y personas de 65 años y más. Se realizaron 90 entrevistas semiestructuradas en las regiones Metropolitana y de Valparaíso entre septiembre de 2020 y enero de 2021. Se identifica la problemática de la sobrecarga informativa para estos grupos y las estrategias que utilizaron para enfrentarla: a) la evitación de información, b) la corroboración de contenidos y búsqueda activa de fuentes confiables, o c) el uso diferenciado de medios

Involvement of phage ϕ29 DNA polymerase and terminal protein subdomains in conferring specificity during initiation of protein-primed DNA replication

To initiate ϕ29 DNA replication, the DNA polymerase has to form a complex with the homologous primer terminal protein (TP) that further recognizes the replication origins of the homologous TP-DNA placed at both ends of the linear genome. By means of chimerical proteins, constructed by swapping the priming domain of the related ϕ29 and GA-1 TPs, we show that DNA polymerase can form catalytically active heterodimers exclusively with that chimerical TP containing the N-terminal part of the homologous TP, suggesting that the interaction between the polymerase TPR-1 subdomain and the TP N-terminal part is the one mainly responsible for the specificity between both proteins. We also show that the TP N-terminal part assists the proper binding of the priming domain at the polymerase active site. Additionally, a chimerical ϕ29 DNA polymerase containing the GA-1 TPR-1 subdomain could use GA-1 TP, but only in the presence of ϕ29 TP-DNA as template, indicating that parental TP recognition is mainly accomplished by the DNA polymerase. The sequential events occurring during initiation of bacteriophage protein-primed DNA replication are proposed

Six month delivery of GDNF from PLGA/vitamin E biodegradable microspheres after intravitreal injection in rabbits

Local long-term delivery of glial cell line derived neurotrophic factor (GDNF) from vitamin E/poly-lactic-co-glycolic acid microspheres (MSs) protects retinal ganglion cells in an animal model of glaucoma for up to 11 weeks. However, the pharmacokinetics of GDNF after intravitreal injection of MSs is not known. We evaluated the GDNF levels after a single intravitreal injection of GDNF/VitE MSs. Biodegradable MSs were prepared by the solid-oil-in-water emulsion-solvent evaporation technique and characterized. Rabbits received a single intravitreal injection (50 μL) of GDNF/VitE MSs (4%w/v; 24 right eyes; 74.85 ng GDNF), blank MSs (4%w/v; 24 left eyes), and balanced salt solution (4 eyes). Two controls eyes received no injections. At 24 hours, 1, 4, 6, 8, 12, 18, and 24 weeks after injection, the eyes were enucleated, and the intravitreal GDNF levels were quantified. Pharmacokinetic data were analysed according to non-compartmental model. Intraocular GDNF levels of 717.1 ± 145.1 pg/mL were observed at 24 hours for GDNF-loaded MSs, followed by a plateau (745.3 ± 25.5 pg/mL) until day 28. After that, a second plateau (17.4 ± 3.7 pg/mL) occurred from 8 to 24 weeks postinjection, significantly higher than the basal levels. Eyes injected with GDNF/vitE and Blank-MSs did not show any abnormalities during the six-months follow up after administration. The single injection of GDNF/VitE MSs provided a sustained controlled release of the neurotrophic factor in a controlled fashion for up to six months

Six month delivery of GDNF from PLGA/vitamin E biodegradable microspheres after intravitreal injection in rabbits

Local long-term delivery of glial cell line derived neurotrophic factor (GDNF) from vitamin E/poly-lactic-co-glycolic acid microspheres (MSs) protects retinal ganglion cells in an animal model of glaucoma for up to 11 weeks. However, the pharmacokinetics of GDNF after intravitreal injection of MSs is not known. We evaluated the GDNF levels after a single intravitreal injection of GDNF/VitE MSs. Biodegradable MSs were prepared by the solid-oil-in-water emulsion-solvent evaporation technique and characterized. Rabbits received a single intravitreal injection (50 μL) of GDNF/VitE MSs (4%w/v; 24 right eyes; 74.85 ng GDNF), blank MSs (4%w/v; 24 left eyes), and balanced salt solution (4 eyes). Two controls eyes received no injections. At 24 hours, 1, 4, 6, 8, 12, 18, and 24 weeks after injection, the eyes were enucleated, and the intravitreal GDNF levels were quantified. Pharmacokinetic data were analysed according to non-compartmental model. Intraocular GDNF levels of 717.1 ± 145.1 pg/mL were observed at 24 hours for GDNF-loaded MSs, followed by a plateau (745.3 ± 25.5 pg/mL) until day 28. After that, a second plateau (17.4 ± 3.7 pg/mL) occurred from 8 to 24 weeks postinjection, significantly higher than the basal levels. Eyes injected with GDNF/vitE and Blank-MSs did not show any abnormalities during the six-months follow up after administration. The single injection of GDNF/VitE MSs provided a sustained controlled release of the neurotrophic factor in a controlled fashion for up to six months

Tocilizumab in refractory Caucasian Takayasu's arteritis: a multicenter study of 54 patients and literature review

Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) was performed. Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5-50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0-31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5-50.0) to 5.0 (0.0-5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0-14.0) months. Twenty-three (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZCOMBO were younger [38.0 (27.0-46.0) versus 45.0 (38.0-57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0-38.0) versus 6.0 (1.0-23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7-5.6) versus 1.3 (0.3-3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal. Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.Funding: This work was partially supported by RETICS Programs, RD08/0075 (RIER), RD12/0009/0013 and RD16/0012 from “Instituto de Salud Carlos III” (ISCIII) (Spain)

Chromatin regulation by Histone H4 acetylation at Lysine 16 during cell death and differentiation in the myeloid compartment

Histone H4 acetylation at Lysine 16 (H4K16ac) is a key epigenetic mark involved in gene regulation, DNA repair and chromatin remodeling, and though it is known to be essential for embryonic development, its role during adult life is still poorly understood. Here we show that this lysine is massively hyperacetylated in peripheral neutrophils. Genome-wide mapping of H4K16ac in terminally differentiated blood cells, along with functional experiments, supported a role for this histone post-translational modification in the regulation of cell differentiation and apoptosis in the hematopoietic system. Furthermore, in neutrophils, H4K16ac was enriched at specific DNA repeats. These DNA regions presented an accessible chromatin conformation and were associated with the cleavage sites that generate the 50 kb DNA fragments during the first stages of programmed cell death. Our results thus suggest that H4K16ac plays a dual role in myeloid cells as it not only regulates differentiation and apoptosis, but it also exhibits a non-canonical structural role in poising chromatin for cleavage at an early stage of neutrophil cell death

Cualificación en los Objetivos establecidos en la Agenda 2030 de estudiantes y profesores en el Máster Universitario en Profesor de Educación Secundaria Obligatoria y Bachillerato, Formación Profesional y Enseñanza de Idiomas (MUPES)

Memoria ID2022-157 Ayudas de la Universidad de Salamanca para la innovación docente, curso 2022-2023

El reto de la inclusión de los Objetivos de Desarrollo Sostenible en la formación inicial de profesores de secundaria: creación del MOOC curso cero sobre educación y ODS, inclusión en asignaturas y en trabajos fin de máster

Memoria ID-041. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2021-2022